Featured topic and speakers
For future physicians approaching residency selection, letters of recommendation can be a vital part of application packets. Suzanne Allen, MD, MPH—vice dean for academic, rural and regional affairs at the University of Washington School of Medicine—offers tips on picking the best letter writers.
Speakers
- Suzanne Allen, MD, MPH, family physician and vice dean for academic, rural and regional affairs, University of Washington School of Medicine
- Brendan Murphy, senior news writer, American Medical Association
Host
- Todd Unger, chief experience officer, American Medical Association
Listen on the go to the full episode on Apple Podcasts, Spotify or anywhere podcasts are available.
Transcript
"So, the people who hopefully know this student the best and are writing letters about their clinical skill level, their engagement with families and patients, how do they do communicating with them? How do they do working on the overall team? So, qualities that I would be looking for of individuals who I would want to help train in the residency program, does that come through in those letters of recommendation that the applicant has?"
Unger: That was Dr. Suzanne Allen, vice dean for academic, rural and regional affairs at the University of Washington School of Medicine—and a family physician. In today’s episode, Dr. Allen will provide you with tips for choosing who should write your letters of recommendation for medical specialty. She’ll also discuss what the process looks like and mistakes to avoid. Here’s AMA senior news writer, Brendan Murphy.
Murphy: Hello and welcome to the Meet Your Match series on Making the Rounds, a podcast by the American Medical Association. I'm Brendan Murphy, senior news writer at the AMA. We're continuing our Meet your Match series with Dr. Suzanne Allen, MD, MPH. She is vice dean for academic, rural and regional affairs at the University of Washington School of Medicine. Dr. Allen is a family physician from Boise, Idaho, and is chair of the AMA Academic Physician Section. How are you today, Dr. Allen?
Dr. Allen: I'm well. Thanks Brandon, and thanks for having me on today.
Murphy: Such a pleasure to have you and this is such an important topic, and timely for our student listeners. Today, Dr. Allen will provide tips for how to choose those very special people in your life, the ones who will write your letters of recommendation from medical residency. So, let's get into it, Dr. Allen. To start, just for background, can you give us some context on how you've been involved in the Match process as a faculty member?
Dr. Allen: Yes, I'm happy to do that, Brendan. During my career, I have spent time working on the family medicine residency side, so I've been someone who's read those letters of recommendations that people have been applying to residency programs. And now in my current position, I actually help students as they get ready for their application process, going through the interview process, and then of course putting together that all important Match list, and then finally getting to celebrate with students on Match Day, which is always fun.
Murphy: That is a great day. We've had so much programming about it on the AMA, and for our rising M4 listeners, that probably feels like a million miles away but in reality, it is on the horizon. One place to get started and a similar vein to letters of recommendation but a slightly different bucket in the application packet, and specifically, is the Dean’s letter. Can we talk about that? What is it and how does it help students form their application?
Dr. Allen: Yeah, absolutely, Brendan. So the Dean’s letter, or what some medical schools might call the MFPE or Medical Student Performance evaluation, is a consistent way for medical schools to share similar information for everyone's application to residency, so that if I'm at a residency program and I'm looking at 10 different applications, the information that is shared through the Dean’s letter or the MSPE will be very similar. And that's one way that the residency programs are able to compare students fairly easily, looking at the information that's consistent across Dean’s letters, whereas when you look at the letters of recommendation, that's a place where we really learn more about the student as an individual versus that consistent information that is shared through the Dean’s letter.
Murphy: And we've certainly heard that over the years from resident faculty that there's a homogeny to the Dean’s letter. Taking that into account, how does a letter of recommendation differ from that and how important is it in the application packet in your view?
Dr. Allen: Yeah, I think both of these are very important, Brendan. So the Dean’s letter, which is going to share when did you enter medical school? How did you do in the classroom phase of medical school? How did you do in the clerkships or clinical phase of medical school? Were you involved in any other kind of specific programs within your medical school? How were you evaluated in the classroom phase and in the clinical phase of your medical school? So those are all the consistent pieces of information that are shared, really, the consistent part. And then the letters of recommendation that you as the student are going to ask faculty for, that's where ‘how you shine yourself as a person’ really comes through. What are your personal characteristics? What are your professional characteristics? How do you interact with people? How do you work on the team? So those are all things that can really be highlighted in that letter of recommendation that can really help your application to a residency program.
Murphy: We're going to do a little role play here as we've frequently done on this podcast. I'm going to pretend I am a soon-to-be residency applicant and I come to you with advice asking for the best way to go about procuring letters of recommendation. What would you tell me?
Dr. Allen: Yeah. Brendan, I'm so excited for you that you're getting ready to do your residency applications. It's very exciting. So first, you're going to need to figure out which specialty you want to go into or if you're going to apply to multiple specialties, which we know students do apply to multiple specialties. As you think about who's going to help you with letters of recommendation, I really encourage you to talk to somebody in the department that you're applying in at your medical school to find out what specifically they recommend you have as far as letters of recommendation. Some specialties, you probably need three letters of recommendation. Some specialties, you might need four letters of recommendation. Depending upon what specialty you're going into, it might be important to have somebody write a letter for you that's helped you do some research if you've participated in research. Other specialties, that won't be nearly as important.
As you're going through your regular required rotations—for most students, that's in their third year—think about who that you've worked with might be a good person to write a letter of recommendation for you. In general, those are going to be people that you've spent a significant amount of time with. So for instance, if you were a student at the University of Washington and you were participating in our longitudinal integrated clerkship, we would highly recommend that the person you spend the most time with during that six-month experience is one of your letter writers. They will know you really well. So if there's a faculty member and you're applying in family medicine and you spent the majority of your required family medicine rotation with that person and you feel that person can write a strong letter for you, that would be a good person to ask even at the end of your required family medicine rotation to write a letter for you.
So really thinking about those letters of recommendation, you start at the beginning of your required clerkships, and certainly by the end of your required clerkships, you want to have probably three or four different people who you feel can write strong letters of recommendation for you. And then, of course, as you do a sub internship or a rotation in whatever specialty you're going into, you also want to make sure you're going to be able to get a strong letter from someone during that rotation as well.
Depending upon the specialty, some will require you to get a letter of recommendation from the chair of the department at your medical school, so again, making sure that you're doing a rotation in that specialty where you will work with faculty within the department is going to be important for your application. So hopefully, that gives you at least a few ideas, Brendan, on things to think about as you're doing your clinical rotations and getting those letters of recommendation.
Murphy: Well, thank you Dr. Allen. I am so excited to begin this application process. The application packet is a pretty comprehensive body of work. The Dean’s letter is part of it, the letters of recommendation are part of it. You mentioned that you've been on the GME side reviewing applications in the past. How important are letters of recommendation compared to other aspects of the packet. Those can be the personal statement, the CV or as we’ve talked about that Dean’s letter.
Dr. Allen: Yeah, great question, Brendan. For me, when I was doing more on the GME side, really reading through that personal statement to get a sense of why someone is interested. In my case, it was in family medicine, why someone is interested in that specific specialty is usually where I started, just to try to get to know that person a little bit and also their interest in our specialty, and potentially, it's specific to the program where I was reading the applications, in this case here in Boise, Idaho. And then I would usually follow that by looking at the letters of recommendation. So the people who hopefully know this student the best and are writing letters about their clinical skill level, their engagement with families and patients, how do they do communicating with them? How do they do working on the overall team? So qualities that I would be looking for of individuals who I would want to help train in the residency program, does that come through in those letters of recommendation that the applicant has?
And then after that, I would tend to look at other things such as the CV or the Dean’s letter where you have maybe more of the, certainly on the Dean’s letter, more of how did they do overall in school? Is it someone who is going to be able to continue to learn is what I would be looking for. And then on the CV, there are other things that they may have participated in, different activities in school. So that was usually the order I followed. Personal statement, letters of recommendation and then the other parts of the application.
Murphy: What types of relationships have you had with students that have led to the best letters of recommendation that you've written?
Dr. Allen: Well, that's a great question. I will say, Brendan, since I've been a vice dean, I haven't been writing letters of recommendation so thanks for asking that question. You're making me think a little bit here. So in general, someone that I've worked with significantly in a clinical capacity is someone who I feel comfortable writing a letter of recommendation for. So I think, as I've said a couple of times, am I able to talk about how they interact with patients? Am I able to talk about how they interact overall with the team? Am I able to talk about their clinical knowledge and their clinical skills? So to me, I have to have worked with them in a clinical setting a number of times to be able to really speak to some of those characteristics that I think are important to be included in that letter of recommendation.
For some rotations that you as a student may be on, of course, it can be hard because you may be working a lot more with residents than with the actual faculty member. In many cases, it's okay to talk with the resident and ask the resident that you may be working with if they would be willing to work with whomever the attending on the team is. Usually, the residents are also evaluating the students on their clinical rotations, but you also need to make sure that you do have a working relationship with the attending who is the person who will be writing the letter that you would be utilizing in your application.
A couple of other things that I usually recommend to students when they are thinking about asking for a letter of recommendation from a faculty member is actually asking the faculty member if they feel comfortable writing the letter and if they feel like they can actually write a strong letter of recommendation for you. One of the reasons behind that is what I feel like would be enough time for me to write a letter of recommendation for someone, a different faculty member may not feel comfortable with that. So sometimes it's hard to put specifics down on paper, or to say specifically in a podcast, just because different faculty feel differently about their ability to write a strong positive letter for someone.
The other thing I usually recommend is asking … some students like to wait until after they get their grade for a required rotation. Other people will ask as they're finishing a required rotation, and then following that up with your CV and personal statement and also a picture of yourself. If you think about the number of students that a faculty member may work with, you do want to make sure that the faculty really knows and understands exactly who they're writing the letter of recommendation for.
So asking somebody by the end of a required rotation or right after you get your grade back, following that up with an email confirming if they're willing to do a letter of recommendation for you, and then when you have your personal statement finished and your CV finished, sending those to the faculty member along with the picture, and of course, always giving them the timeline of when you need that letter of recommendation by. I think all of that really helps. It certainly helps on the faculty side, I think, and helps the student in really clarifying with the faculty member what it is that the student is requesting from them.
Murphy: Is there a way to make an impression with a faculty member or even follow back up and talk about a difficult case or even some common ground you had? "Hey, you remember me? We're both Red Sox fans," or something like that. Is that something that might be effective here?
Dr. Allen: Yeah, absolutely, Brendan. That's a great way to connect with your faculty and potentially to connect with the faculty even as you're wrapping up that required rotation. Talking about what excited you about that particular rotation, potentially a difficult case or an interesting case that you worked with the faculty member on. I would say the Seattle Mariners, but okay, the Red Sox is fine as well. Any of those sorts of things where you have had a connection with the faculty, it does make a huge difference and does help the faculty to remember you as an individual.
Murphy: The Meet Your Match podcast, I should point out, has no official affiliation with the Boston Red Sox. I'm in Cubs country here in Chicago. Dr. Allen is in Mariners country out west. So, we touched on this a little but is there other information that you think is key to be included in a letter that we didn't touch on earlier?
Dr. Allen: Yeah, I think the only thing, Brendan, maybe that hasn't been mentioned yet is just clarifying what specialty the student is going into. As the applicant, the student can ask for as many letters of recommendation as they want. They can only, depending upon which specialty you're applying in and if you're going through the Match or the San Francisco match, so the NRMP or San Francisco match, you can do four letters or three letters that will be sent to a specific program. So as a student, you might have 10 or 12 different letters of recommendation and you might say, "I'm going to send these four letters to that program in Boise and I'm going to send a different four letters to this program in Montana," or wherever it might be. And so, making sure that the faculty mentions the specialty can be really helpful in the letter.
And then you as the student need to make sure you're attaching the correct letter to the correct residency program in your ERAS application so that if you are applying to two different specialties, you make sure that the right letter gets to the right specialty. And for many students, if they've done a rotation in a specific area, say you're going to medical school in Boston but you're applying to residency programs on the West Coast and you did a sub-I at a program say at the University of Washington and you've got a letter of recommendation from them, you may want to make sure that that letter of recommendation from the program on the West Coast is utilized for residency programs on the West Coast, but maybe you're not utilizing that for residency programs on the East Coast.
So you can kind of mix and match, if you will, your letters of recommendation, so making sure the specialty you're applying to is mentioned in the letter of recommendation and that you as the student are very clear with the faculty what you're asking them to write the letter for, and then making sure you're very specific about which program gets which letters is important.
Murphy: So a takeaway for our student audience there is you're going to have multiple letters no matter what. Can you talk about the breakdown: What type of experiences all your letter writer should have? Is there going to be some variation? Is it okay, for instance, if you have someone from your preclinical training as a letter writer?
Dr. Allen: Yeah, great question, Brendan. So yes, I actually think it is good to have a variety of different letters available when you apply. A couple of things: you do want to make sure that you have a letter in the specialty you're applying in that's specific to that. So, for instance, if you're applying in emergency medicine, you would want to have a letter from an emergency medicine rotation by an emergency medicine faculty. If you're in family medicine, you want to make sure that you have a letter from a family medicine rotation by a family medicine faculty. Some specialties then would also say you need to have a letter from the chair of the department, so making sure that you've checked in with someone in your department that you're applying in and that you really understand what are the requirements in that particular specialty will be important as you think about which letters to choose.
For instance, in family medicine, because we hear for people across the span of the lifetime, then if there's someone that you had a rotation where you felt like you connected, they got to know you really well; we would be happy to see those letters. It might be a pediatrician, it might be an internist, it might be an obstetrician. Any of those would be really acceptable within family medicine. We, of course, would prefer it to say that the faculty who is writing that letter feels like you'll be an excellent family medicine resident, to be clear that you're applying in family medicine, which I think is very helpful.
Clearly, someone who has worked with you in the classroom phase of medical school, especially if it's someone who helped you with your clinical skills training in some fashion, or potentially someone that you did research with, I think those are all important people who have gotten to know you over a period of time and can really speak to your professionalism, to the way you approach learning, lifelong learning skills, so those are great letters to have as well.
Murphy: There's a lot of leg work students need to do. It sounds like one thing students can do is to get ahead of the game by asking early. What else can students do to make things easier on letter writers? And what information should students be providing their letter writers?
Dr. Allen: Yeah. So as I think we've talked about a little bit, Brendan, making sure that you're able to provide your CV and your personal statement can be really helpful to letter writers, making sure that they know what specialty you're applying in, and then a timeline. So, for most students, when they're ready to finalize their application in MyERAS, which residency programs can be what's in MyERAS, usually in September, students can start uploading things into MyERAS in June. So for instance, for students who are starting residency in summer of '23, ERAS opened in June of 22. Residency programs started receiving those applications in September of '22. So for this upcoming year, ERAS will open in June of '23. Residency programs can see those applications in September of '23.
So you want to make sure that if you want those letters of recommendation in by September, that you're giving your letter writers at least six weeks. Many places will say four to six weeks but usually six weeks before you want that letter to be finalized. So if you want all your letters in by September 1, you would want to let your faculty know, "Oh, thank you for writing this letter. Here's my CV, my personal statement. I'm applying in family medicine and can you please complete this by September 1?" If you don't see that letter then within a month of the faculty member confirming with you that yes, they will. They're happy to write this letter and they'll have it done by June 1, sometimes a gentle reminder by the end of August can be really helpful for that faculty member.
And another thing just to remember is that you can continue to update your letters of recommendation throughout the application process, so you can ask some people as you finish your personal statement, you can ask people way back in May or to finish a letter sometime in June of '23, and that is acceptable as well because you can continue to upload them and connect a specific letter to a specific program. And then as you continue on, you can keep updating them. So say you're doing a rotation somewhere in August and that's in a specialty that you're applying in, you can ask at the end of that rotation if they're willing to write a letter of recommendation for you and give them a deadline of say, October 15, October 1, October 15, and you can still utilize that letter. Some programs won't look at your application unless you do have a certain number of letters of recommendation, so that's why we encourage people to have their letters of recommendation basically in by the middle of September if possible, realizing that some of them may not arrive until October, and that's okay as well.
Murphy: So speaking generally, students are not going to see their letter of recommendation. MyERAS however, does offer applicants the right to do that, they also offer them the opportunity to waive that right. Should students waive that right?
Dr. Allen: Yeah, thanks for asking that question, Brendan. Just following up on your last question, I probably should have mentioned that one of the things students need to make sure and provide to their faculty members is how to upload the letter of recommendation into the MyERAS application for the student. So thank you for reminding me of that, Brendan, and important for students to include that information when they communicate with faculty. In general, I recommend that students waive their right to see the letter of recommendation. I just remember on the residency side, we always were slightly concerned about why would a student not waive their right? What was it that a faculty member might say about that student that the student was concerned about? That made us concerned. Was there something that wasn't being shared with us about a student because the student didn't waive their right?
Usually, it's because students forget to check the box that they're waiving their right, just to be clear, but on the residency side, you always worry about that. So, I do recommend to students that they waive their right to see the letter of recommendation, and in general, if you're worried that a faculty member may not write a strong letter of recommendation for you, that's probably not the best person to ask for a letter of recommendation. You do want to make sure that faculty feel comfortable and are able to tell you that they feel good about writing a strong letter of recommendation for you.
Murphy: If a faculty member isn't comfortable or you don't get the response you want, how do you not take that personally as a student?
Dr. Allen: Oh, great question. I think it's really hard to not take that personally, Brendan. I think all of us would take that personally. And I think as a faculty member, it can be challenging on how to respond to a student if you don't feel that you can write them a strong letter of recommendation. I have had faculty tell me … the most common thing I hear from faculty is they feel they didn't spend enough time with a student to write a strong letter of recommendation for them, which I know from a student perspective still can feel frustrating and hard and it still feels like you take that personally.
So when I try to reframe things for students on this, I usually try to say, "It's better to know from a faculty member that they don't feel they can write you a strong letter of recommendation than it is for them to write you a letter that's not helpful for your application, and that for you as a student, when you're a practicing physician and you have someone ask you for a letter of recommendation, you want to be able to feel like you can be honest with the person asking you as well." So really trying to help the student focus a little bit on the faculty being honest with them, but also making sure that they're going to get strong letters of recommendation for their application is how I've tried to help students through, because that is a difficult situation to be in, Brendan.
Murphy: When we went through the aspects of the application packet, you highlighted that the personal statement is, if not the most important, it's certainly your first impression. How should your personal statement inform the people you picked to write your letters?
Dr. Allen: Yeah, it's a great question. So when we're working with individuals in the hospital or in clinic and on a team, we're very frequently focused on caring for the patients and those day-to-day tasks. They're important for all of us to pay attention to in the care of patients, so I think the personal statement is a way to really share a little bit more of who you are? What makes you tick? What are the reasons that you went into medicine? And not all of that comes out when you're working with somebody on a day-to-day basis. And I do think helping the faculty who is going to write a letter for you see what those motivating factors are of who you are and why you're passionate about what you're doing is something that can help them connect the dots of what they saw you doing as a student and how you were caring for your patients.
So I do think that being able to share your personal statement and really showing faculty, you as an individual and why you went into medicine can make a big difference in helping them to really write a strong positive letter for you.
Murphy: What are some mistakes students make when selecting their letter writers?
Dr. Allen: So one of the things that I see not infrequently is they want who they consider to be the best known name of people that they worked with to write their letter, who may be a person that they interacted with some but maybe didn't work with them as much as a more junior faculty member who maybe doesn't have as much name recognition but can actually write a much stronger letter because they spent more time with you. So I think really focusing on who got to know you during a rotation rather than, "Oh, this is someone who has written X number of papers and is going to be known nationally if not internationally, but maybe didn't work with me a ton on the rotation," that's probably the biggest mistake that I see students making.
I do feel like in most cases, if the specialty you're applying in requires a chair letter, the chair will be someone who is probably well known and can be the person who helps in that regard. But otherwise, really focusing on who's the faculty you spent the most time with and got to know you the best, even if it's one of the junior faculty in the department I feel is going to be a better letter for your application than trying to have someone who's more senior but didn't spend more time with you.
Murphy: Of course, it's probably worth reiterating what you said earlier, that there are administrative tasks to getting your letters, and certainly, that is an area that is ripe from a mistake if you don't give writers enough time, if you don't give them the proper upload link. Besides that, do you have any other thoughts on letter writing and any other advice for medical students?
Dr. Allen: Oh, I think the big thing, Brendan, that we talked about earlier was really thinking about this early on. So, I realize that we might have rising fourth years out there listening to this, but even if you're a first, second or third year, it's never too early to start thinking about this. Really thinking about every required rotation or a research experience that you're doing or like a service-learning project that you're spending time on, any of those can also be great opportunities for getting a letter. So planning ahead on getting those letters, really making sure that you're talking with someone in the department of the specialty you're applying in at your school to make sure you're doing what they recommend around number of letters of recommendation and who they should be from, I think those are probably the big things for medical students to really be thinking about as they start thinking about those residency applications.
Murphy: And application season is on the horizon so it's an exciting time for everyone.
Dr. Allen: Yes, it absolutely is. It's exciting to have people who have recently graduated, new residents starting, residents finishing programs, fellowships starting, students thinking about applying to residency programs. The summer is always a busy time in medical education.
Murphy: Well, thank you so much for taking the time to be with us today, Dr. Allen. I should also say thanks to our listeners for tuning in to the Meet Your Match series on the Making the Rounds channel. I'm AMA senior news writer, Brendan Murphy. Tune in next time.
Dr. Allen: Thanks, Brendan.
Unger: Don’t miss an episode of this special series. Subscribe to Making the Rounds on your favorite podcast platform or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
